Health Care Law Blog

Federal Assistance to Providers and Required Coverage of COVID-19 Testing by Insurers

This blog has since been updated with new information since its original publication. Due to rapidly changing laws and regulations surrounding COVID-19 matters, please consult your attorney and/or advisor for the latest information before taking any action.

The Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act (CARES) require insurers to cover diagnostic testing for COVID-19 without any cost-sharing or prior authorization requirements. The Trump Administration and Centers for Medicare and Medicaid recognize that financial barriers that deter individuals from receiving testing for COVID-19 must be eliminated, since testing is critical to slowing the spread of the virus.

On April 11, 2020, the Department of Labor, Department of Health and Human Services, and the U.S. Department of the Treasury issued guidance on frequently asked questions relating to provisions of the FFCRA and CARES Act that require coverage for testing. Under the FFRCA, group health plans and health insurance issuers offering group or individual health plans are required to cover benefits and related services for diagnostic testing of COVID-19 with no cost-sharing requirements. This means that the insurer cannot charge a deductible, co-payment, or coinsurance for an individual tested for COVID-19. These requirements apply to insured and self-insured group health plans, private employment-based group health plans under ERISA, non-federal governmental plans, church plans, coverage offered in the individual market, and student health insurance coverage.

Coverage of testing and services relating to testing of COVID-19 must be provided cost-free during the emergency period which will end on June 16, 2020 unless the Secretary of HHS extends or terminates the emergency period. In addition to the test, the insurer must provide items and services furnished to the individual during office visits, urgent care visits, and emergency room visits that result in an order of a diagnostic test for COVID-19, but only to the extent that the services relate to the furnishing of the test or determining the need for such test. The guidance clarifies that insurers must provide coverage for serological tests used to detect antibodies of the virus, despite the current belief of the Food and Drug Administration that such tests should not be the sole basis for a diagnosis of COVID-19.

The CARES Act requires plans and insurers to reimburse providers of COVID-19 testing at a negotiated rate, or the cash price listed on the provider’s public website for out-of-network providers. Additional assistance to providers was established through the CARES Act Provider Relief Fund. An initial $30 billion was immediately distributed beginning April 10, 2020 as support payments to eligible providers fighting the COVID-19 pandemic. On April 22, HHS announced that its targeted allocation for the CARES Act Provider Relief Fund include:

• distributions to COVID-19 high-impact areas;
• distributions for treatment of the uninsured;
• distributions to rural providers;
• distributions to Indian Health Service facilities; and
• separate, additional funding for skilled nursing facilities, dentists, and providers that solely take Medicaid.

As of April 27, 2020, health care providers who provide treatment for uninsured COVID-19 patients can register for reimbursement through the COVID-19 Uninsured Program. Providers may begin submitting claims electronically on May 6, 2020, and may begin receiving reimbursement in mid-May.

All facilities and providers that received Medicare fee-for-service reimbursements in 2019 are eligible, including health systems, group practices and sole practitioners. Eligible providers must agree not to seek collection of out-of-pocket payments for treatment from a COVID-19 patient greater than what the patient would have paid to an in network provider. Payments are to be distributed based on the provider’s share of total Medicare fee-for-service reimbursements in 2019. These payments do not need to be repaid.

The FAQs on coverage requirements under the FFCRA and the CARES Act is available here. More information about the CARES Act Provider Relief Fund is available here. Foster Swift continues to track the regulations and relief for health care entities related to COVID-19. Contact a member of the health care group for any questions on required coverage, relief through the CARES Act Provider Relief Fund, or guidance on navigating the COVID-19 Uninsured Program Portal.

• Jennifer Van Regenmorter; jvanregenmorter@fosterswift.com

Categories: Employee Benefits, Health Care Reform, Medicaid Planning, Medicare/Medicaid